Healthcare Provider Details

I. General information

NPI: 1760475784
Provider Name (Legal Business Name): MICHAEL J FARRELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4417 VESTAL PARKWAY EAST SUITE 300
VESTAL NY
13850-3556
US

IV. Provider business mailing address

4417 VESTAL PKWY E SUITE 300
VESTAL NY
13850-3556
US

V. Phone/Fax

Practice location:
  • Phone: 607-240-2885
  • Fax: 607-240-2886
Mailing address:
  • Phone: 607-240-2885
  • Fax: 607-240-2886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number203308
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: